Service Request Form 2020 - Brushy Creek MUD

Please use the form below to connect or disconnect Water Utility Service. Once you click the submit button below your request will be sent to the District's Customer Service Department and a Customer Service Representative will respond within one business day.

Last Name_First Name

Main Phone

Phone

Home
Work
Cell

Driver License Number or Business EIN

Driver License State

Your Email Address

Property Type

Residential
Commercial

Service Request Information

New
Final
Transfer*

Service Request Date

Service Address

City

Round Rock, TX
Austin, TX

Zip Code

Billing or Forwarding Address

Same as above
See billing address below
Forwarding Address - See billing address below

Billing Street City State Zip

Standard is 1 Solid Waste Cart and 1 Recycle Bin

Additional Solid Waste Cart
Additional Recycle Cart

Paperless Billing

Yes, Go Paperless
No, please mail me a bill

1st Authorized Account Individual Name

1st Authorized Account Individual Phone Number

2nd Authorized Account Individual Name

2nd Authorized Account Individual Phone Number

Previous resident of the Brushy Creek MUD

Yes
No

Investment or rental property

Yes
No

PRIVACY ACT: The District is obligated under the Texas Open Records Act to give out personal and private information on customers (Such as name, address, telephone number, social security, etc.). Under the act, this information is accessible to salesman, bill collectors, disgruntled spouses, telephone solicitors, junk mail listing or anyone else that may want to know about you and your account.If you DO NOT want any information given out regarding you or your account, please initial below.

Initials Agreeing to Privacy Act

Fees:

Standard 5/8" meter Deposit + $30 Admin Fee ($130)

3/4” Meter Deposit + $30 Admin Fee ($180)

Transfer Fee $30

Weekend Fee $60

Signature

Date Signed

PLEASE NOTE: Request made will be processed twenty four (24) hours after contact by BCMUD and payment (Deposit / Admin Fee) is made. Service request can only be made Monday - Friday except for Holidays and extenuating circumstances.

Notes

*** Click SUBMIT at the bottom (scroll past "Staff Use Only")

- - - For Staff Use Only - - -

Received By and Date Received

Receipt Number

Account Number

Meter Size

Work Order

Water Service Request Form

Fees:

*** Click SUBMIT at the bottom (scroll past "Staff Use Only")